Trachs - fenestrated versus non-fenestrated

[Enthused RN, BSN, RN]

I'm still a nursing student and recently I gave report to another nurse where she asked me a question that made me think. The patient I was handing off had a trach and she wanted to know whether it was a fenestrated or non-fenestrated. I wasn't sure why it was relevant when we were talking about a comatose patient with little chance recovering to baseline function much less being able to speak again (I made that clear at the beginning of report). Is there a different way of providing care for a fenestrated trach versus a non-fenestrated one? I'm not sure if I'm missing something important here or if she just forgot that the patient is non-communicative? I really don't want to miss anything and as a student, I felt too inferior to ask why she wanted to know for this particular patient.

Moderators - if I posted in the wrong forum, please move the thread as necessary. Thanks!

[Double-Helix, BSN, RN]

A fenestration is an opening in the cannula of the tracheostomy above the level of the cuff. It allows more air to pass through the vocal cords and out the mouth, enabling easier/louder speech and cough production in patients with a tracheostomy. However, while the fenestration allows air to move up, it also allows other things to move down, such as saliva, secretions, gastric contents or tube feeding.

There's a few reasons why the nurse asked about what kind of trach the patient had.

1. So she knows. If the doctor asks, if she needs to document it, if the trach needs to be changed, if she needs to make sure the correct spare trach is at the beside, then she needs to know whether it's fenestrated or not.

2. If the patient is at risk for aspiration and requires a cuffed trach to maintain the airway then it's important for the nurse to know if the trach is fenestrated because the fenestration basically defeats the purpose of a cuff. So the nurse will need to make sure that the inner cannula of the trach is not fenestrated in order to have the true benefits of a cuffed trach.

Patients can still speak with an unfenestrated trach. As long as the cuff is deflated air can flow around the sides of the trach and out through the vocal cords. A fenestration makes it easier, though.

This nurse may have also had another reason for asking about the trach. We don't work with fenestrated trachs that much in pediatrics, so I'm not familiar with any differences in care. But next time, don't be afraid to just ask her why that piece of information is important. :-)

[Enthused RN, BSN, RN]

Awesome explanation! Your response helped me learn a few things, especially about how a fenestrated trach can put a patient at risk for aspiration. The patient in question was on aspiration precautions so her question about whether it was fenestrated or not was very relevant then.

[Esme12, ASN, BSN, RN]

Sure it is relevant......if the trach is fenestrated she needs to be hyper vigilant to ensure they don't aspirate. Just because a patient is on precautions for aspiration doesn't lessen the risk that they will aspirate.

Maybe this patient should have their trach changed to a non fenestrated one....it was a very pertinent question to ask and to have the answer for.... the patient had and you should have known what type/size of trach the patient has in if you had been caring for them all day.

What kind a trach a patient has in place is a very pertinent question. What size was it? What if something happened? What if you needed another trach emergently ...do you know what you would ask for?

So yes it's relevant. VERY relevant to your patients airway.

[Enthused RN, BSN, RN]

I was able to answer the questions, I just didn't know the relevance of it until now.